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Transplantation in patients with iron overload: is there a place for magnetic resonance imaging?

Transplantation in iron overload

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Abstract

In iron overload diseases (thalassemia, sickle cell, and myelodysplastic syndrome), iron is deposited in all internal organs, leading to functional abnormalities. Hematopoietic stem cell transplantation (HSCT) is the only treatment offering a potential cure in these diseases. Our aim was to describe the experience in the field and the role of magnetic resonance imaging in the evaluation of iron overload before and after HSCT. Magnetic resonance imaging (MRI), using T2*, is the most commonly used tool to diagnose myocardial-liver iron overload and guide tailored treatment. Currently, HSCT offers complete cure in thalassemia major, after overcoming the immunologic barrier, and should be considered for all patients who have a suitable donor. The overall thalassemia-free survival of low-risk, HLA-matched sibling stem cell transplantation patients is 85–90%, with a 95% overall survival. The problems of rejection and engraftment are improving with the use of adequate immunosuppression. However, a detailed iron assessment of both heart and liver is necessary for pre- and post-transplant evaluation. In iron overload diseases, heart and liver iron evaluation is indispensable not only for the patients’ survival, but also for evaluation before and after HSCT.

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Authors and Affiliations

  1. Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, Palaeo Faliro, Athens, Greece

    Sophie Mavrogeni, Genovefa Kolovou & Stamatis Adamopoulos

  2. Athens, Greece

    Sophie Mavrogeni

  3. Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12200, Berlin, Germany

    Boris Bigalke

  4. Department of Cardiology, Leopoldina Hospital, 97422, Schweinfurt, Germany

    Angelos Rigopoulos

  5. Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany

    Michel Noutsias

Authors
  1. Sophie Mavrogeni
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  2. Genovefa Kolovou
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  3. Boris Bigalke
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  4. Angelos Rigopoulos
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  5. Michel Noutsias
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  6. Stamatis Adamopoulos
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All authors have equally contributed to the creation of this manuscript

Corresponding author

Correspondence to Sophie Mavrogeni.

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Funding Information

MN has received grants from the Deutsche Forschungsgemeinschaft through the Sonderforschungsbereich Transregio 19 “Inflammatory Cardiomyopathy” (SFB TR19; TP B2), and by the University Hospital Giessen and Marburg Foundation Grant (UKGM 10/2009 “T cell functionality in DCMi”). MN has been consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin) in 2004–2008, and has received honoraria for presentations and/or participated in advisory boards from AstraZeneca, Bayer, Fresenius, Miltenyi Biotec, Novartis, Pfizer, and Zoll.

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The authors declare that they have no conflict of interest.

Abbreviations

TMthalassemia

SCAsickle cell anemia

MDSmyelodysplastic syndrome

MRImagnetic resonance imaging

OHT/OLTorthotopic heart and liver transplantation

HSCThematopoietic stem cell transplantation

MELDmodel for end-stage liver disease

IOCiron overload cardiomyopathy

GVHDgraft-versus-host disease

HbShemoglobin S

CMRcardiovascular magnetic resonance

MUDmatched unrelated donor

mMUDmismatched unrelated donor

UCBumbilical cord blood

RHCresidual host hematopoietic cells

BMTbone marrow transplantation

TRMtransplant-related mortality

HLAhuman leukocyte antigen

CYcyclophosphamide

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Mavrogeni, S., Kolovou, G., Bigalke, B. et al. Transplantation in patients with iron overload: is there a place for magnetic resonance imaging?. Heart Fail Rev 23, 173–180 (2018). https://doi.org/10.1007/s10741-018-9670-7

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  • DOI: https://doi.org/10.1007/s10741-018-9670-7

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